As an outbreak of Ebola swept through central Uganda in late September, government officials were ready to do anything to contain the virus except take one crucial step: impose a lockdown.
It was radically different from their response at the start of the coronavirus pandemic, when Uganda introduced some of the most restrictive lockdowns in Africa by closing borders, banning public transport and closing schools for two years – l one of the longest closures in the world.
Officials in Uganda, a landlocked East African country, now acknowledge that they were hesitant to impose similar restrictions during the recent Ebola outbreak due to lingering anger, resentment and trauma over the strict Covid measures. They worried that another harsh response to an outbreak could spark protests, hit an already strained economy and alienate a weary population awash in misinformation about the dangers — and even the existence — of Ebola.
The initial decision not to isolate the epicenter of the Ebola outbreak has come to haunt Uganda. The disease has spread to nine districts, including the capital, Kampala. The World Health Organization has reported 142 confirmed cases and 55 confirmed deaths, with 22 additional deaths likely linked to the outbreak.
“We should have done it much more aggressively,” said Henry Kyobe Bosa, an epidemiologist who manages the Ebola response at the Department of Health. But he added: “Remember, we’re coming from Covid, and you don’t want to disrupt people’s lives as much as possible.”
The outbreak, the country’s deadliest in more than two decades, has now largely subsided and no new Ebola infections have been reported recently. But those affected wonder if all the pain could have been avoided.
Among those who died was 12-year-old Ssebiranda Isaiah Victor, whose relatives gathered on a recent overcast afternoon for a memorial service in Nakaziba, their village in the lush hills of central Uganda.
The family lived in Kampala and the boy’s father, Ssekiranda Fred, said his son contracted the virus from a neighbor’s child who arrived from Kassanda, one of the districts at the center of the outbreak.
Mr Fred said that if the government had taken strict measures to tackle the virus, “perhaps things would not have gone the way they did”.
“I miss you, my son,” he said. “He was so brilliant, a dreamer.”
Ebola, a highly contagious disease mostly seen in Africa, causes fever, fatigue, and bleeding eyes and nose. The virus kills about half of the people it infects. The highest number of deaths, 11,325 people, was recorded during an epidemic in West Africa from 2014 to 2016. An epidemic in the Democratic Republic of Congo in 2018-2020 killed 2,280 people.
In recent years, Uganda has suffered from multiple epidemics, including Marburg measles and poliomyelitis, which have strained its health system.
So when Covid-19 hit, authorities introduced sweeping restrictions, which had devastating effects on the country’s 47 million people. Rights groups and opposition members argued the measures were part of an effort to crack down on dissent ahead of last year’s hotly contested election and the bloody months that followed.
Ugandan health officials said they were reluctant to issue another blanket lockdown when the Ebola virus was detected, despite recommendations from medical experts and aid groups who urged them to quickly halt movement towards and from areas where cases have arisen.
“This is a public health emergency of international concern, and the government has kind of fallen behind,” said a senior aid official involved in the Ebola emergency response, who, as others spoke on condition of anonymity to discuss sensitive issues. “They wanted to give the general impression that the epidemic is under control.”
Finally, on October 15, nearly a month after the first case of Ebola was reported, President Yoweri Museveni announced a dusk-to-dawn curfew and restriction of movement in and out. outside Mubende and Kassanda, the districts where the epidemic was concentrated.
By then, the virus had spread to the capital. People who had been in contact with Ebola patients from Mubende escaped quarantine. Mr Museveni said in a speech that a contact concealed his identity and address to seek treatment from a traditional healer in a nearby district. He later died in Kampala.
“They were really determined not to block anymore because they knew the public trust was not there,” said another senior Western health official with knowledge of the emergency response. But with the virus in Kampala, the official said, “they felt pushed into it”.
At that time, the United States had issued an order to screen all Ugandan travelers arriving at US airports. Many tourists were also postponing or canceling their trips to Uganda, threatening a tourism industry that was betting on the upcoming holiday season to recover from the staggering losses of the pandemic, said Herbert Byaruhanga, president of the Uganda Tourism Association and manager of a bird-surveillance company.
“It’s like adding salt to the wound,” Mr Byaruhanga said.
The Ugandan public’s lack of confidence in the government’s response to Ebola has created fertile ground for misconceptions, including the belief that Ebola is caused by witchcraft and that burials of Ebola victims are kept closed – no not to prevent contagion, but so that their organs can be harvested and sold.
At a motorbike taxi stop in Kassanda, nearly a dozen people gathered recently to insist to reporters that Ebola did not exist. The lockdown, they said, was intended to punish the district for backing the opposition party led by musician-turned-politician Bobi Wine in the 2021 election. They also accused police of beating them to enforce the night curfew.
“Where is Ebola? Mutumba Alex, a taxi driver, asked. Waving his driver’s license, he said he knew the area well and had seen no evidence of illness or death from the disease. “Ebola does not exist.”
But the reality in Kassanda was different for Nantale Rashida, who said she faced stigma and discrimination from her neighbors when her husband, Asadu Matovu, tested positive for Ebola. Mr Matovu recovered, but lost his mother and two brothers to the virus.
To prevent Ms Rashida and her children from going anywhere, the community “tied ropes around our plot”, she said. “I spent all day and all night crying.”
Multiple corruption cases linked to the coronavirus pandemic have also eroded citizens’ trust in their leaders.
The United States, which has donated more than $22 million to fight Ebola, is also concerned about corruption, said Natalie E. Brown, US Ambassador to Uganda. The vast majority of donations from the United States and other donors have gone through aid agencies rather than directly to the Ministry of Health – a move that has infuriated Ugandan officials, according to interviews with aid officials. .
Corruption has even hit Ebola patients. A report prepared by health officials in Kassanda and seen by The New York Times noted that Ebola survivors complained that police confiscated their property and demanded bribes to release them.
There are vaccines to prevent Ebola, but there are no approved vaccines or drug treatments for the Sudanese strain of the virus, which caused the recent outbreak in Uganda. A clinical trial of three vaccines – carried out by the Sabin Vaccine Institute in Washington, the University of Oxford and the American pharmaceutical company Merck – is In preparation. Researchers have also started a clinical trial of two monoclonal antibodies donated by the United States that may help increase patients’ chances of survival.
Some experts say, however, that with no new cases of Ebola reported in Uganda at present, a critical opportunity to advance understanding of the Sudanese strain of Ebola may have been missed.
For now, families across Uganda are mourning their loved ones.
Days after losing her son to Ebola in mid-October, Mr Fred’s wife of 22 years, Nakku Martha, succumbed to the virus. Mr Fred was in solitary confinement when the two died and he was unable to attend any of the burials. Although he was crying, he said, he remained grateful that the virus had not taken his three remaining sons.
“Ebola could have wiped us all out,” he said with tears in his eyes one recent afternoon as he strolled around his son’s tiled grave, covered in banana trees. “But we survived and remain hopeful.”
Musinguzi Blanshe contributed reporting from Kampala, Uganda.
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